Dr. Brian Gantwerker: COVID-19 pandemic deeply concerning for private practices

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Neurosurgeon Brian Gantwerker, MD, has been in private practice for nine years as president and CEO of The Craniospinal Center of Los Angeles in Santa Monica and Encino, Calif. 

There's no secret about the costs and reimbursement challenges physicians in private practice have been facing. For them, COVID-19 has come at a particularly bad time.

As the U.S. braces for a projected spike in COVID-19 cases, further cost-cutting and downsizing will be expected as many private practices look to push through this challenging period.

Here, Dr. Gantwerker discusses how COVID-19 will affect physicians in private practice and how the healthcare industry is pivoting to telehealth amid the spread of the novel coronavirus.

Question: How has the COVID-19 outbreak impacted your practice so far?

Dr. Brian Gantwerker: On one hand, there have been a lot of patients that have canceled and rescheduled appointments. On the other hand, hospitals are forcing us to cancel elective cases. Since the federal advisory, we've started offering patients Facetime and Skype appointments and I think that's going to take over for us, at least for the Medicare side. The question is will commercial payers follow suit? But for those patients who have had surgery and may be experiencing problems, if they can't come in, how will we be able to properly assess them? Digital technology is helpful but it doesn't replace an in-person visit.

Q: Do you see telemedicine becoming more widespread after the pandemic begins to flatten?

BG: Yes, I think this is the kick commercial payers needed to jumpstart telemedicine initiatives. Something that can come of this is teaching the health insurance companies that these tele-appointments can work and are a viable alternative to in-person visits. That's what we're hoping because they've been very hesitant to make telemedicine a service that they'll allow us to offer and be reimbursed for. I think in a way, COVID-19 will have a positive effect in terms of moving us into a more digital age. 

Q: How hard will physicians in private practice be hit by COVID-19, given there are many already dealing with costs and reimbursement challenges?

BG: It's a heck of a challenge. A colleague of mine has overheads of $80,000 per month that he has to clear just to stay open and he may have to downsize significantly because of this. Some of my other colleagues are working to get disaster relief SBA loans to help them. I think it will drive a lot of practices to cut staff. We've already been in a cost-cutting mode for about three months and COVID-19 has been prompting us to be more aggressive about it. The downside is you may have healthcare workers and people working in private practices lose their jobs. 

It will negatively impact everyone's practice, from the people who work there up to the owners of the practices themselves. We won't feel it right now but we'll feel it in six to eight weeks. A lot of people are going to draw down on their lines of credit, max their credit cards and credit scores. It's a very difficult time to be a private practitioner. I'm hoping we'll find some respite in SBA loans that may just be able to help us get back on our feet. 

Q: How have your colleagues in hospital and health systems adjusted their workflows over the past few days? 

BG: Just in the last three days, a ton of physicians are switching over to telehealth and telemedicine. Even some of my older colleagues are making telehealth and telemedicine available at their practices. One of my internal medicine colleagues has temporarily decided to do all telehealth appointments. He has blended virtual and in-person visits until this point but now has gone full telehealth. 

The other big change is that people are looking at their businesses now in a very different way. They're now looking at how to protect their families and fulfil their duties. That's been a tough question for all of us to answer. Some of us have children at home and elderly relatives that we don't want to pass anything on to, so we feel stuck in a way. Some of the hospitals are not providing a service to the healthcare professionals working there. Physicians and nurses are on the front lines and hospitals need to protect them as much as they protect their patients. 

Q: How do you think the response to the COVID-19 has gone so far?

BG: I've been most impressed with the individual state governor's responses, especially New York Gov. Andrew Cuomo. He was right on the money giving state briefings every morning for the past two weeks and he has great data-driven analytics that offer a way for people to conceptualize the numbers he's talking about. So, he's really asking the federal government to send over the Army Corps of Engineers to construct field hospitals and facilities where patients can get seen, which is all in anticipation of this huge wave of patients coming in. 

That's what we saw the Chinese do — they built these massive field hospitals in a matter of days. For the federal government, we appreciate the money and the telehealth, but we really need something to happen in terms of fostering the availability of more beds. That's what is keeping hospital administrators and chief medical officers up at night — not having enough beds and being overwhelmed with patients. 

Q: Where do you think the federal government could have done better?

BG: I think the federal government really could have done a better job at getting us testing kits. At the end of the day we really don't know how many people actually have been exposed or infected with COVID-19 because we don't have enough testing kits. That needs to be fixed ASAP along with the number of available beds. 

There will be a spike in cases but we need to figure out if the spike is due to people finally being tested or is it due to an increase in the number of new cases. it's important for people not to panic and pay close attention to the data and close attention to trustworthy media outlets and the CDC.

If you are a spine surgeon or orthopedic industry representative and wish to share your experiences or thoughts on this matter, please contact Alan Condon at acondon@beckershealthcare.com.

More articles on practice management:

NuVasive recalls Magec system for scoliosis, advises surgeons to perform clinical follow-ups
Zimmer Biomet asks European hospitals to remove orthopedic spacer molds
Resurgens Orthopaedics postpones elective surgeries, remains open for urgent care

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